Gender Clinics
A gender clinic is a specialist service that assesses you before recommending hormones. Where informed consent treats the consent conversation as enough, a gender clinic usually wants one or more appointments with a clinician who explores your history and your goals, and a diagnosis, before hormones are started.
In the UK this is the only route the NHS offers, and its main challenge is the wait. Many people plan around it by combining routes: on the NHS waiting list, private for the assessment or the prescription, and asking their GP to take over prescribing to keep costs down. Most of the British patients I coordinate for surgery in Bangkok have done some version of this, and this page explains how the pieces fit together.
On this page
How the assessment model works
At an assessment-led clinic, a clinician, often a psychologist, psychiatrist or specialist doctor, meets you to talk through your gender history, what you want from treatment, your general and mental health, and your support. The aim is to confirm a diagnosis of gender incongruence and that hormones are a sensible next step.
Some clinics do this in one appointment. Others want two, sometimes months apart, especially where the service works to older versions of the WPATH Standards of Care. After assessment, an endocrinologist or specialist doctor recommends a hormone plan, and blood tests follow.
The assessment is not a test you pass by saying the right things. It is a conversation, and being honest about doubts or a non-binary goal is fine. A good clinician adjusts the plan rather than rejecting you for it.
What helps is having the practical things to hand: your medical history and current medicines, any previous blood results, whether you smoke, and what you want from hormones in plain terms. If you have already been taking hormones, say so and say what; it changes the plan, not whether you get one.
Before an assessment appointment
Write down when you first knew, what you have already changed socially, what you want hormones to do and what you are unsure about. Nerves make people forget things, and a clinician would rather see honest notes than a rehearsed story.
The NHS route in the UK
In England, you are referred to an NHS gender identity clinic (GIC) for adults, usually by your GP, and in some areas you can refer yourself. Scotland, Wales and Northern Ireland have their own services and referral routes.
Then you wait. The wait for a first appointment at most adult GICs has been several years, and at some clinics much longer. Check the current figure for the clinic you are referred to, and remember that a published wait is often based on who the clinic is seeing now, not how long someone referred today will wait.
While you wait, keep your GP practice and the clinic updated with any change of address, name or contact details, so an appointment offer, or a letter asking you to confirm you still want your place, does not go astray.
After assessment, the GIC recommends hormones and usually asks your GP to prescribe and do the blood tests under a shared care arrangement, with the GIC advising. Some newer NHS pilot services work more closely with primary care from the start.
The rules for under-18s in the UK have changed significantly in recent years and are still changing. This page is about adult services only.
As soon as you are sure you want to explore hormones
Get the referral in, even if you plan to go private. Your place on the NHS list is measured from the referral date, it costs nothing to hold, and it keeps an NHS option open for later.
Going private in the UK
Private gender clinics in the UK offer the same kind of assessment and prescribing, with waits of weeks or months rather than years. Some are led by specialists who used to work in NHS GICs; others are online services. Standards vary, so check who the clinicians are and whether they are on the General Medical Council register.
You pay for the assessment, follow-ups, blood tests and the prescription itself, unless your GP takes over prescribing. Cost and insurance has typical figures.
Going private does not remove you from the NHS list, and many people do both.
Shared care with your GP
Shared care is an arrangement where a specialist recommends a treatment and your GP agrees to prescribe it and do the routine monitoring. For NHS GIC patients it is the standard model. For private patients it is where the money is saved, because the medicine and bloods move onto the NHS.
GPs are not obliged to agree to shared care, and some decline, particularly when the recommending clinic is private or overseas. If yours does, ask for the reason in writing. Sometimes it is a practice policy, sometimes the GP wants a specific kind of letter or monitoring plan from the private clinic, and sometimes another GP in the same practice will take it on.
Before you commit to a private clinic
Ask your GP practice whether it will take on shared care from that particular clinic. Some practices have a list of private providers they will and will not work with, and it is much easier to know before you have paid for the assessment.
Bridging prescriptions
A bridging prescription is a GP prescribing hormones to someone who is waiting for specialist care, usually because they are already taking hormones without supervision. General Medical Council guidance allows it in limited circumstances, as a harm-reduction step, to avoid people carrying on with unmonitored hormones.
In practice it is patchy. GPs are cautious, and many want advice from a specialist before bridging. If you are already self-medicating, being open with your GP about exactly what you take and asking for blood tests is worth doing whether or not they will bridge, because it gets your health monitored.
Canada, Australia and the US
In Canada and Australia most people start hormones with a family doctor, GP or nurse practitioner, often on an informed-consent basis. Specialist gender clinics there mostly see more complex cases, people with other health conditions, and surgery referrals. Access outside the cities can be thin.
In the US there is no single route. Some people see an endocrinologist through a hospital gender programme, where a letter or assessment may be required; others use informed-consent clinics or telehealth. Insurers sometimes want a diagnosis and supporting letter before they will pay, even when the prescriber would not, so an assessment can matter for coverage even where it does not matter for the prescription. State laws differ and change, in both directions.
Frequently asked questions
How long is the NHS gender clinic wait?
Several years for a first appointment at most adult clinics in England, longer at some. Published figures change, so check the current wait for your clinic. See the NHS route in the UK.
Can I go private and stay on the NHS list?
Yes. Going private does not remove you from the list, and many people do both. See going private in the UK.
Will my GP prescribe hormones a private clinic recommends?
Some will, under a shared care arrangement; GPs are not obliged to. Ask before you pay for a private assessment. See shared care with your GP.
What is a bridging prescription?
A GP prescribing hormones for someone waiting for specialist care, usually because they are already self-medicating, to keep them safe in the meantime. See bridging prescriptions.